This symposium represents an international collaborative effort between members of the Japanese Respiratory Society, The European Respiratory Society, Canadian Thoracic Society, and the American Thoracic Society to foster interactions towards a precision medicine approach to severe asthma. Globally, severe asthma represents a subset of asthma accounting for approximately 5-10% of patients with asthma. However health care utilization for this subset has been estimated to be up to 40% of the total economic burden of asthma. Recently there have been significant efforts to determine the underlying basis for this disease in terms of epidemiology, physiology, immunology, and genetics that influence this phenotype. Data is emerging that severe asthma consists of several subsets termed 'endotypes'. This phenotypic and now molecular classification may greatly aid in patient management with improved disease control, improved clinical outcomes and reduced medical costs. This symposium will highlight recent advances as well as highlight needed areas of research to advance treatment and prevention of this disease.